高危腹壁疝修补术的负压切口创面治疗：一项随机对照试验与荟萃分析。
完整摘要 · 中文译文
背景：尽管假体材料和外科技巧不断进步，腹壁疝修补术后的伤口相关并发症仍然常见，并且是术后并发症的主要决定因素。我们试图评估负压伤口治疗（NPWT），这是一种低成本干预措施，旨在改善伤口结局，并已在其他外科情境中得到证实。 方法：我们报告了一项多中心随机对照试验（RCT），评估NPWT与无菌敷料在具有1项或多项术后手术部位并发症危险因素的接受腹壁疝手术修补的成年患者中的效果。我们的主要结局是任何手术部位并发症的复合结局。次要结局是成本效果和生活质量，使用疝相关生活质量调查（HerQLes）进行评估。我们对本研究及另外2项RCT进行了荟萃分析。 结果：在110例符合纳入标准的患者中，107例在中位随访33天时具有主要结局数据。主要结局在NPWT组54例患者中发生于15例（27.8%），在对照组53例患者中发生于25例（47.2%），相对危险度为0.59（95%置信区间[CI] 0.35至0.99）。荟萃分析发现合并相对危险度为0.56（95% CI 0.39至0.81）。NPWT组术后生活质量显著更高（HerQLes评分88.3 [95% CI 75.8至94.2] 对 73.3 [95% CI 52.5至93.3]）。NPWT的成本效果为每质量调整生命年160美元。 结论：在高风险腹壁疝修补术中预防性使用NPWT可降低手术部位并发症的发生率 离子，与更高的术后生活质量相关，并且具有很高的成本效益。
完整摘要 · 英文原文
BACKGROUND: Despite advances in prosthetic material and surgical technique, wound-related complications after ventral hernia repairs remain common and a primary determinant of postoperative morbidity. We sought to evaluate negative pressure wound therapy (NPWT), a low-cost intervention to improve wound outcomes that has been proven in other surgical contexts. METHODS: We report a multicentre randomized controlled trial (RCT) evaluating NPWT versus sterile dressing in adult patients undergoing surgical repair of ventral hernias with 1 or more risk factors for postoperative surgical site complications. Our primary outcome was the composite of any surgical site complication. Secondary outcomes were cost-effectiveness and quality of life, evaluated using the Hernia-Related Quality-of-Life Survey (HerQLes). We conducted a meta-analysis of this study and 2 other RCTs. RESULTS: Of 110 patients who met inclusion criteria, 107 had primary outcome data at a median follow-up of 33 days. The primary outcome occurred in 15 (27.8%) of 54 patients in the NPWT group and 25 (47.2%) of 53 patients in the control group, for a relative risk of 0.59 (95% confidence interval [CI] 0.35 to 0.99). Meta-analysis found a pooled relative risk of 0.56 (95% CI 0.39 to 0.81). Postoperative quality of life was significantly higher in the NPWT group (HerQLes score 88.3 [95% CI 75.8 to 94.2] v. 73.3 [95% CI 52.5 to 93.3]). Cost-effectiveness of the NPWT was US$160 per quality-adjusted life year. CONCLUSION: Prophylactic NPWT in high-risk ventral hernia repair reduces the incidence of surgical site complications, is associated with a higher postoperative quality of life, and is highly cost-effective.